A Qualitative Study Describing the Perspectives on Frailty and its Management in Individuals with Kidney Failure

Background Frailty is highly prevalent among individuals with kidney failure and independently associated with poor health outcomes. Identifying and managing frailty can inform prognosis and care but stakeholders’ understanding of frailty and their perspectives on how to detect and manage it in routine kidney care are unknown. Methods We recruited participants from four Canadian kidney programs in Alberta, Manitoba, and Nova Scotia from January 2021-June 2023. We conducted focus groups and semi-structured interviews with patients (age ≥50 years with dialysis-dependent or non-dependent kidney failure), caregivers, allied health care professionals (HCPs), and nephrologists. We used Qualitative Description and inductive thematic analysis to describe their perspectives. Results Ninety-one people participated: patients (N=31), caregivers (N=8), kidney allied HCPs (N=38) and nephrologists (N=14). We identified three themes, each with subthemes: 1. What is frailty? All groups expressed uncertainty, but frailty was commonly described as physical, visible, inevitable, and fixed. 2. Discussing frailty: the value of knowing what to expect with frailty, and frailty as a difficult topic to discuss. 3. Frailty assessment and management: skepticism from patients and caregivers that frailty is measurable; support from clinicians for a systematic approach to identifying frailty but a lack of knowledge on multidisciplinary roles and potential interventions. For all groups, having actionable solutions after identifying frailty was key for acceptability and successful implementation. Conclusions Education on the nature and potentially modifiable aspects of frailty as well as the scope and potential benefits of frailty interventions is necessary for successful implementation of frailty detection and management in kidney care.